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01-12-2024 | Kidney Cancer | Original Article

Long-term functional outcomes in patients undergoing radical nephrectomy for renal cell carcinoma and tumor thrombus

Authors: Pietro Scilipoti, Giuseppe Rosiello, Alessandro Larcher, Giuseppe Fallara, Daniele Cignoli, Chiara Re, Giacomo Musso, Francesco Cei, Zhe Tian, Pierre I. Karakiewicz, Alexandre Mottrie, Francesco Trevisani, Daniele Raggi, Andrea Necchi, Roberto Bertini, Andrea Salonia, Alberto Briganti, Francesco Montorsi, Umberto Capitanio

Published in: World Journal of Urology | Issue 1/2024

Abstract

Background

Up to 15% of patients with locally advanced renal cell carcinoma (RCC) harbors tumor thrombus (TT). In those cases, radical nephrectomy (RN) and thrombectomy represents the standard of care. We assessed the impact of TT on long-term functional and oncological outcomes in a large contemporary cohort.

Methods

Within a prospective maintained database, 1207 patients undergoing RN for non-metastatic RCC between 2000 and 2021 at a single tertiary centre were identified. Of these, 172 (14%) harbored TT. Multivariable logistic regression analyses evaluated the impact of TT on the risk of postoperative acute kidney injury (AKI). Multivariable Poisson regression analyses estimated the risk of long-term chronic kidney disease (CKD). Kaplan Meier plots estimated disease-free survival and cancer specific survival. Multivariable Cox regression models assessed the main predictors of clinical progression (CP) and cancer specific mortality (CSM).

Results

Patients with TT showed lower BMI (24 vs. 26 kg/m²) and preoperative Hb (11 vs. 14 g/mL; all—p < 0.05). Clinical tumor size was higher in patients with TT (9.6 vs. 6.5 cm; p < 0.001). After adjusting for potential confounders, the presence of TT was significantly associated with a higher risk of postoperative AKI (OR 2.03, 95% CI 1.49–3.6; p < 0.001) and long-term CKD (OR: 1.32, 95% CI 1.10–1.58; p < 0.01). Notably, patients with TT showed worse long-term oncological outcomes and TT was a predictor for CP (2.02, CI 95% 1.49–2.73, p < 0.001) and CSM (HR 1.61, CI 95% 1.04–2.49, p < 0.03).

Conclusions

The presence of TT in RCC patients represents a key risk factor for worse perioperative, as well as long-term renal function. Specifically, patients with TT harbor a significant and early estimated glomerular filtration rate (eGFR) decrease. However, despite TT patients show a greater eGFR decline after surgery, they retain acceptable renal function, which remains stable over time.

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Title: Long-term functional outcomes in patients undergoing radical nephrectomy for renal cell carcinoma and tumor thrombus
Authors: Pietro Scilipoti
Giuseppe Rosiello
Alessandro Larcher
Giuseppe Fallara
Daniele Cignoli
Chiara Re
Giacomo Musso
Francesco Cei
Zhe Tian
Pierre I. Karakiewicz
Alexandre Mottrie
Francesco Trevisani
Daniele Raggi
Andrea Necchi
Roberto Bertini
Andrea Salonia
Alberto Briganti
Francesco Montorsi
Umberto Capitanio
Publication date: 01-12-2024
Publisher: Springer Berlin Heidelberg
Keywords: Kidney Cancer
Kidney Cancer
Kidney Cancer
Acute Kidney Injury
Acute Kidney Injury
Chronic Kidney Disease
Nephrectomy
Nephrectomy
Nephrectomy
Renal Cancer
Published in: World Journal of Urology / Issue 1/2024
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-024-04976-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Long-term functional outcomes in patients undergoing radical nephrectomy for renal cell carcinoma and tumor thrombus

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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